Prospective association of daily ambulatory activity with metabolic syndrome in middle-aged and older Japanese adults: the Toon Health Study.

BACKGROUND: This cohort study aimed to examine the relationship between objectively measured daily ambulatory activity (AA) variables and the onset of metabolic syndrome (MetS) in middle-aged and older Japanese individuals. METHODS: A total of 1,034 participants (women, 76.8%; mean age, 56.9 years) who were initially free from MetS, underwent objective assessment of daily AA using a uniaxial accelerometer at baseline. The number of steps, time accumulated in light-intensity AA (LIAA), moderate-to-vigorous intensity AA (MVAA), and total AA (LIAA + MVAA) were calculated. The diagnostic criteria outlined by the Japanese standards were employed to define the presence of MetS. To explore the association between AA variables and MetS onset, both multivariate logistic regression and a restricted cubic spline model were used while controlling for variables such as age, sex, education, alcohol habit, smoking habit, energy intake, and the number of MetS components present at baseline. RESULTS: Over the course of the 5-year follow-up period, 116 participants (11.2%) developed MetS. In terms of the number of steps, LIAA, and total AA, the third quartile had significantly lower multivariate adjusted odds ratios for MetS onset than the first quartile. The odds ratios (95% confidence intervals) were 0.386 (0.197-0.755), 0.527 (0.285-0.975), and 0.392 (0.206-0.745), respectively. In the spline model, an L-shaped association with MetS was observed for the number of steps (p for nonlinearity = 0.066), LIAA (p for nonlinearity = 0.034), and total AA (p for nonlinearity = 0.040). CONCLUSIONS: Among the variables related to AA, the index of daily amount AA, in particular, may be linked to the onset of MetS.

Latent profile analysis approach to the relationship between daily ambulatory activity patterns and metabolic syndrome in middle-aged and elderly Japanese individuals: The Toon Health Study.

BACKGROUND: This cross-sectional study aimed to identify the accumulation patterns of objectively measured ambulatory activity (AA) variables in the Japanese middle-aged and elderly individuals and examine the relationship of these derivative patterns with metabolic syndrome (MetS). METHODS: A total of 1850 participants (66.1% women, mean age: 57.7 years) provided objectively assessed AA data using a uniaxial accelerometer. The number of steps, time accumulated in light-intensity AA (LIAA) and moderate-to-vigorous intensity AA (MVAA), and the ratio of MVAA to total AA (LIAA + MVAA) were calculated. Latent profile analysis was used to identify groups of participants based on their distinct AA patterns. Logistic regression models were used to assess the association of groups with MetS after adjusting for age, sex, alcohol intake, and cigarette smoking. RESULTS: Four distinct groups were identified: Group A had few steps and low levels of LIAA and MVAA; group B had a certain number of steps and recommended level of MVAA but low level of LIAA; group C had a certain number or more of steps, high level of LIAA, and recommended level of MVAA; group D had an extremely high number of steps and high levels of both LIAA and MVAA. The multivariate-adjusted odds ratio (95% CI) for MetS in groups B, C, and D relative to group A were 0.857 (0.611-1.201), 0.679 (0.500-0.922), and 0.434 (0.259-0.730), respectively. Groups C and D had significantly lower odds ratio of MetS compared to group A. CONCLUSION: AA pattern involving a certain number or greater of steps accumulated through not only MVAA but also LIAA may help reduce the risk of MetS compared to inactive AA pattern.

Role of insulin resistance in the association between resting heart rate and type 2 diabetes: A prospective study.

BACKGROUND: Elevated resting heart rate (RHR) is a predictor of incident type 2 diabetes (T2D). Insulin resistance is thought to play a role in this association; however, the extent to which insulin resistance mediates this association is unclear. METHODS: 1309 Japanese individuals without diabetes were recruited during 2009-2012 and followed for 5 years, of whom 78 developed T2D, as diagnosed by the 75 g oral glucose tolerance test. Supine RHR was measured by electrocardiography. Using logistic regression analysis, we examined the association between RHR and incident T2D, and interaction with the homeostasis model assessment of insulin resistance (HOMA-IR) index. Causal mediation analysis was applied to decompose the effect of RHR on the outcome and estimate the proportion mediated by the HOMA-IR index. RESULTS: The sex- and age-adjusted cumulative incidence rate of T2D increased with increasing RHR. After adjustment for sex, age, waist circumference, current smoking status, alcohol use, habitual exercise, and cardiovascular disease medications, individuals with a RHR ≥80 bpm, compared with <60 bpm, showed an increased risk of incident T2D [odds ratio (OR), 2.89; 95 % confidence interval (CI), 1.07 to 7.80]. Multivariate adjusted OR for the total effect per 1 SD increase in RHR on incident T2D was 1.37 (95 % CI, 1.01 to 1.74) in the mediation analysis, and the proportion of the total indirect effect mediated by the HOMA-IR index was 27.5 % (95 % CI, 1.5 to 53.5). CONCLUSIONS: Approximately 30 % of the effect of RHR on incident T2D was explained by the indirect effect of insulin resistance.

Association of diagnostic delay with medical cost for patients with Crohn's disease: A Japanese claims-based cohort study.

BACKGROUND AND AIM: Longer diagnostic delay (DD) in Crohn's disease (CD) is associated with complications and related surgeries. However, the impact of DD on medical cost after CD diagnosis remains uncertain. METHODS: This was a claims-based cohort study. Our analysis used data from 2005 to 2018 from the Japanese Claims Database. We enrolled a total of 528 newly diagnosed CD patients (76.9% male) aged 31.5 ± 13.6 years. High medical cost was defined as the highest quartile of the average monthly medical cost. DD was defined as the interval between the first visit to a gastroenterologist and diagnosis with CD. In the multivariable logistic regression analysis, patients were stratified by the use of anti-tumor necrosis factor alpha (anti-TNFα) agents to exclude their influence on the observed effects. This study was approved by the ethics review board of the Juntendo University Faculty of Medicine (No. 2019178). RESULTS: The multivariable-adjusted odds ratios and 95% confidence intervals of high medical cost were 1.41 (0.81-2.43) and 0.91 (0.57-1.46), respectively, for a DD of >12 months and 1 to ≤12 months compared to <1 month. In patients receiving anti-TNFα agents, the multivariable-adjusted odds ratios for high medical cost were 2.63 (1.34-5.16) and 1.35 (0.79-2.28) for a DD of >12 months and 1 to ≤12 months, respectively, compared to <1 month. In patients without anti-TNFα, multivariable logistic regression analyses were not presented because of a small number of patients categorized into the high medical cost group. CONCLUSION: A delayed diagnosis of CD may incur high medical cost in patients who develop aggressive disease that requires treatment with anti-TNFα agents.

Association Between Heart Rate Variability and Home Blood Pressure: The Toon Health Study.

BACKGROUND: Although blood pressure (BP) is regulated by the autonomic nervous system, it is not fully understood how autonomic activity affects BP at home in the general population. METHODS: Subjects were enrolled from 2009 to 2012 and included 1,888 men and women aged 30-79 years. We measured casual BP in the morning during health checkups and asked participants to monitor BP at home twice in the morning and evening for 1 week. The mean of the two measurements of mean arterial pressure (MAP) was calculated. Five-minute recordings of the pulse wave from a fingertip sensor were used to determine the following indices of heart rate variability (HRV): standard deviation of normal-to-normal RR intervals (SDNN), root mean square of successive differences in RR intervals (RMSSD), high frequency (HF) power, low frequency (LF) power, and LF/HF. RESULTS: Sex- and age-adjusted means of casual MAP, and morning and evening MAP at home were significantly different among quartiles of SDNN, RMSSD, and HF. When further adjusted for smoking, alcohol drinking, medication for hypertension, diabetes, sleeping hours, snoring, and mental health status, the associations were somewhat attenuated. Inverse relationships were found between the means of morning home MAP, and RMSSD (P = 0.02) and HF (P = 0.051) after adjustment for confounders. The association between MAP and RMSSD, or MAP and HF was evident in individuals <65 years old. CONCLUSION: Low HF and RMSSD, which reflect impaired parasympathetic nervous system activity, were associated with increased home MAP in the morning rather than in the evening.

Yellow Tongue Coating is Associated With Diabetes Mellitus Among Japanese Non-smoking Men and Women: The Toon Health Study.

BACKGROUND: Yellow tongue coating is one of the clinical signs for diabetes mellitus according to traditional East Asian medicine. Few reports have been available on the association between yellow tongue coating and the prevalence of type 2 diabetes in the general population. We examined that association among population samples of non-smoking men and women. METHODS: The study subjects were Japanese non-smoking men (n = 315) and women (n = 654) aged 30-79 years who resided in Toon city and participated in the Toon Health Study from July 2011 through November 2014. Tongue coating was assessed by a nationally licensed acupuncturist and classified into three categories of white (normal), light yellow, and yellow. We performed an oral glucose tolerance test to confirm the presence of diabetes mellitus and prediabetes. The associations between yellow tongue coating and the prevalence of diabetes mellitus and prediabetes were examined using multivariable logistic regression analyses, adjusting for age, sex, body mass index, drinking status, and physical activity. RESULTS: The multivariable odds ratios of diabetes mellitus were 1.39 (95% confidence interval [CI], 0.72-2.67) for light yellow tongue coating and 2.23 (95% CI, 1.16-4.30) for yellow tongue coating compared with white tongue coating. The respective multivariable odds ratios of prediabetes were 1.13 (95% CI, 0.80-1.61) and 1.43 (95% CI, 0.96-2.12). CONCLUSIONS: Yellow tongue coating was associated with higher prevalence of diabetes mellitus and tended to be associated with that of prediabetes among Japanese non-smoking men and women.